BUTUAN CITY GOVERNMENT PERFORMANCE EVALUATION FORM For the Rating Period _______________________ EMPLOYEE: _________________________ POSITION : _________________________

PART 1 WEIGHT 50% WORK/ACTIVITY I.BEDSIDE CARE 1.ADMITS &DISCHARGE PATIENT 2.ASSESS PATIENT CONDITION 3.ADMINISTERS MEDS.& TREATMENT PERFORMANCES QUANTITY UNIT OF MEASURE/INDICATOR TARGET -NO OF ADMISSION/DISCHARGES -NO. OF PATIENTS ASSESSES - NO. OF MEDS.&TREATMENT ADMINISTERED 4.PREPARES PATIENTS FOR OPERATION -NO. OF PTS. FOR OPERATION & & DIAGNOSTIC PROCEDURES DIAGNOSTIC PROCEDURES 5.GIVE HEALTH TEACHINGS -NO. OF PTS. TAUGHT -NO. OF DOCTORS ASSISTED & NO. OF ORDERS EXECUTED 589 ACCOMP. 889 TARGET ACCOMP TARGET within ACCOMP. QN 6 QL T APS EPS QN 10 QL 10 8 T APS 9.33 EPS 46 TARGETS AND ACCOMPLISHMENTS QUALITY TIME SUPERVISORS

OFFICE: BUTUAN MEDICAL CENTER UNIT: NURSING SERVICE

RATING EMPLOYEE

96% 97% SATISFACTORY PERFORMANCE

months

20% 10% 10% 5%

II.ASSISTS DOCTORS ROUNDS & EXECUTE ORDERS

292 277 118 117

422 465 197 182

95% ACCURATE

96% months

10 10 10 10 10 every 1 st or 2nd friday of the month

10 10 10 10 10

8 10 10 10 8

9.33 10 10 10 9.33

186 1 1 0.5 0.46

III.RECORDS IN PATIENTS CHARTS, -NO. OF RECORDS MADE OBSERVATION,MEDICATION & DIET LIST IV.SUPERVISE NSG. ATTENDANT,VOLUN- -NO. OF PERSONNEL SUPERVISE TEERS & U.W. V.CHECK WARD SUPPLIES & -NO. OF TIMES CHECKED EQUIPMENTS VI.ATTENDS MONTHLY MEETINGS/ CONFERENCES - NO. OF MEETINGS ATTENDED

5%

95% 96% ACCURATE 95% 97% IMPROVE SKILL SERVICE&ATTITUDE 95% 96% SATISFACTORY PERFORMANCE 95% 96% ABSORBED & IMPLEMENTED

TOTAL EQUIVALENT POINT SCORE BY PERCENTAGE WEIGHT ALLOCATION DISCUSS AND AGREE OF THE ABOVE TARGETS LEGEND: QN QUANTITY QL- QU ALITY T - TIMELINESS APS AVERAGE POINT SCORE EPS - EQUIVALENT POINT SCORE _____________________________ RATER ______________________ ________________________ RATEE DATE PERC ACTION

9.42 X 70%= 6.59